鼻腔NK／T细胞淋巴瘤68例临床分析

目的 探讨鼻腔NK/T细胞淋巴瘤各种治疗方法 及影响预后的因素.方法 回顾性分析该院收治68例鼻腔NK/T细胞淋巴瘤,其中男性45例,女性23例,中位年龄46岁.32例采用了单纯放疗,7例单纯化疗,29例放疗与化疗联合治疗.放疗采用直线加速器6MV X线或电子线,或钴60照射.IE期患者照射野采用＂L＂形野,＂凸＂形野,或耳前野加筛窦野,颈部淋巴结不做预防性照射.Ⅱ期患者在肿瘤侵及颈部时应用面颈联合野和下颈切线野,加或不加筛窦电子线野.中位放疗剂量50 Gy.化疗采用CHOP方案,4～8个疗程.结果 单纯放疗组CR率87.5%,5年生存率68.75%;单纯化疗组CR率14.3%,5年生存率14.3%;放化疗联合组,其中先化疗后放疗者,CR率65.2%,5年生存率60.9%;先放疗后化疗者,CR率83.3%,5年生存率66.7%.Ⅰ期患者CR率78.2%,5年生存率65.5%;Ⅱ期患者CR率60%,5年生存率50%;Ⅲ/Ⅳ期患者CR率和5年生存率为0.结论 鼻腔NK/T细胞淋巴瘤放疗的疗效明显优于化疗.鼻腔NK/T细胞淋巴瘤对放疗敏感,而对化疗相对抗拒.早期鼻腔NK/T细胞淋巴瘤患者应接受放射治疗或以放疗为主的综合治疗.晚期患者预后极差,晚分期是独立的预后不良因素.

Clinical analysis of 68 eases with nasal NK/T-cell lyraphoma

Objective To investigate the therapeutic modality and prognosis of nasal NK/T-cell lymphoma. Methods Data from 68 cases of nasal NK/T-cell lymphoma in our Hospital was retrospectively reviewed, of which 45 were male cases, 23 were female cases and the median age was 46 years. Of these patients, 32 received radiotherapy alone, 7 chemotherapy alone and 29 chemo-radiotherapy. Radiotherapy alone adopted linear acceler-ator 6MV X- ray or electronic ray or CO-60 radiation. Radiation field of patients in stage IE adopted ＂L＂ field, ＂凸＂ field or preauricular field and ethmoid field. Lymph node of neck didn＇ t adopt preventive radiation. Patients in stage II a- dopted faciocervical joint field and lower cervical tangential field with or without ethmoid electronic linear field when tumors intruded the neck. The median radiotherapy dose is 50 Gy. Chemotherapy adopted CHOP project with 4 - 8 courses of treatment. Results Local affection of 30 cases of the group of radiotherapy alone completely remitted, the CR rate was 87.5% and the 5-year overall survival（OS） rate was 68.75%. The CR rate of the group of chemotherapy alone was 14. 3%, and the 5-year OS was 14. 3%. The CR rate and the 5-year OS of the patients received chemotherapy first and radiotherapy second in the group of chemo-radiotherapy were 65.2% and 60. 9%, while radiotherapy first and chemotherapy second were 83.3% and 66.7%. The CR rate of the patients in stage I was 78.2%, and the 5-year OS was 65.5% ; the CR rate of the patients in stage II was 60% and the 5-year OS was 50%. The 5-year OS of the patients in stage III/IV wash＇ t got. Conclusion Therapeutic effect of radiotherapy is obviously superior to chemotherapy for nasal NK/T-cell lymphoma. Nasal NIL/T- cell lymphoma is sensitive to radiotherapy while relatively fast to chemotherapy. Patients of nasal NK/T-cell lymphoma in early stage should adopt radiotherapy or general treatment with radiotherapy as primary treatment. Patients in late stage will get bad prognosis with late staging as the independent prognostic factors.